Like most of American healthcare, kidney care has for decades been plagued by red tape.
asserted
care → plague → tape
The Trump administration says it wants to change that.
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it → say → that
On Tuesday, Department of Health and Human Services (HHS) Secretary Robert F. Kennedy Jr. announced his department's Kidney Care National Plan, which promises to introduce more competition, reduce regulatory barriers, expand patient choice, and overhaul America's kidney transplant system.
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which → announce → system
Much of the plan focuses on barriers to entry in dialysis care, which treats nearly 558,000 Americans.
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which → focus → Americans
While dialysis can be performed at home, most patients receive treatment at specialized facilities, which must comply with federal certification requirements governing equipment, staffing, water quality, and patient safety in order to participate in Medicare.
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which → perform → Medicare
Kennedy argues that regulatory barriers have discouraged competition and innovation, leaving patients with fewer dialysis treatment options.
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barriers → argue → options
"Dialysis technology is an extraordinary technology," said Kennedy at the press conference, but "because of monopolies in the system and the barriers to new entrants, we have not seen any real improvements in that technology.
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we → say → technology
Of course, the existence of large or even monopolistic companies is not in itself evidence of a problem, but government regulation can often entrench those companies' positions in the market.
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regulation → entrench → market
"I like the fact that they're recognizing that a lot of regulatory…barriers are contributing to the problem, and that's refreshing to hear," says Jeffrey Singer, a practicing general surgeon and senior fellow at Reason Foundation, the nonprofit that publishes Reason.
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that → like → Reason
Singer says that removing barriers that prevent new companies from competing with established providers could not only increase choice but also drive down prices.
uncertain
that → say → prices
HHS says that two companies, DaVita and Fresenius Medical Care, control approximately 74 percent of the American dialysis market.
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companies → say → market
As of 2019, roughly a third of Americans lived in areas where the only available dialysis provider was one of those two companies, according to the agency.
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provider → live → agency
The administration argues that government regulation has helped entrench this dominance by making it difficult for new providers to enter the market.
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providers → argue → market
To address this, the Kidney Care National Plan suggests a number of reforms, including simplifying certification requirements.
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Plan → address → requirements
HHS also plans to investigate whether dominant dialysis providers have used payment arrangements and legal strategies to secure higher reimbursements without delivering better care.
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providers → plan → care
The 17-page report calls for a review of existing requirements, but it does not specify which regulations will be repealed, nor does it establish a timeline for doing so.
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it → call → timeline
It also does not propose any significant reduction in the government's role in financing the distorted market.
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It → propose → market
Instead, the plan largely seeks to make existing government-financed systems such as Medicare more competitive and efficient.
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systems → seek → Medicare
Kennedy has also correctly identified the need for reform regarding kidney donations.
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Kennedy → identify → donations
Nearly 90,000 people are waiting for a kidney transplant at any given time in America, and 11 people die every day waiting for a kidney.
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people → wait → kidney
The transplant process is currently managed by Organ Procurement Organizations (OPOs), which are federally certified nonprofits responsible for recovering organs from donors and coordinating their transfer.
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which → manage → transfer
argues that they behave as "regional monopolies."
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they → argue → monopolies
Since no new OPOs have been approved in the last year, the Kidney Care National Plan suggests fast-tracking certification.
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Plan → approve → certification
The plan also seeks to make living kidney donation easier by reducing financial barriers.
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donation → seek → barriers
Following the passage of the Honor Our Living Donors Act in February, HHS revised federal reimbursement rules so that a donor's eligibility for financial assistance is no longer determined by the transplant recipient's income.
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eligibility → follow → income
Eligible donors can receive up to $6,000 to cover expenses, including travel, lost wages, and childcare.
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donors → receive → travel
However, the reforms proposed stop short of allowing kidney donors to receive direct compensation for the organs themselves, which remains prohibited under federal law.
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which → propose → law
"I can sell my blood.
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I → sell → blood
Why can't I sell my kidney?" Singer asks.
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Singer → sell → kidney
Peter Jaworski, director of the Georgetown Blood and Plasma Research Group, feels similarly, arguing that financial incentives are available to nearly everyone involved in kidney transplantation except the donors themselves.
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incentives → feel → donors
"According to this plan, it's OK to use incentives to encourage them to be more productive, to actually do a better job," Jaworski tells Reason, referring to transplant surgeons, hospitals, and organ procurement organizations.
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Jaworski → accord → surgeons
"The only exception, once again, is the donor who is offering a kidney.
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who → offer → kidney
Better solutions exist, according to Jaworski, who points to the proposed End Kidney Deaths Act.
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who → exist → Act
The bill, which was introduced by Rep. Nicole Malliotakis (R–N.Y.) last year, would offer living kidney donors a $50,000 refundable tax credit, distributed over five years.
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which → introduce → years
"We have those systems in order to make sure that we can treat patients.
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we → have → patients
America's plasma market is an excellent example of financial incentives encouraging donation.
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market → encourage → donation
Unlike many other countries, the U.S. allows plasma donors to be compensated, and despite accounting for just over 4 percent of the world's population, it supplies approximately 68 percent of the plasma collected globally for manufacturing medicines.
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it → allow → medicines
"Why do you think America does it?
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America → think → it
Is it because in America there's way more altruism than in France or Italy or Belgium?
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it → be → France
No, it's because in the United States you can be paid to donate plasma," argues Jaworski.
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Jaworski → pay → plasma
…and 4 more, not listed.
The Aporia
